Torn biceps question

I tore my long biceps muscle from the shoulder while leaving the blocks at Nationals on Sunday. It is what is called a "proximal" (by the shoulder) tear of the "longer" of the two biceps muscles. If it were a "distal" tear, where the biceps attachs near the elbow, the standard course is surgery to reattach. This is not always the case with a proximal tear. I just saw an orthopedic surgeon who recommended no surgery for my tear. I will seek a second opinion as I have a two week window if I want to have it surgically reattached.

My reason for posting is to ask if anyone has had a proximal (shoulder end) biceps tear. What did you do? I want to maintain swimming at an intense level and am not sure how much is lost if I do not have surgery. And I understand that even with surgery there are no guarantees of complete recovery.

Any information about a biceps tear and treatment would be appreciated.

Re: Torn biceps question

Hi Greg,
Sorry I couldn't do both Trials and Nationals. Would haloed to catch up.

Re your problem. I had my right biceps tendon reattached in 2001 operation that included rotator cuff repair. The reason I opted for this procedure was that the recovery was about the same length as for the rotator cuff. The outcome was fine.

In 2005 I messed up my left labrum and the MRI indicated my left biceps tendon was hanging by a thread, so I decided to just have it released as the recovery was much shorter and matched my labrum recovery. As with the reattachment, the outcome was perfect. Zero problems with a much shorter recovery.

Re: Torn biceps question

Greg, very sorry to hear about your injury. I did a bit of Internet searching, as I suspect you may have done, too. Here is one snippet I found that you might find encouraging:

What is the treatment for a proximal biceps tendon rupture?
Patients usually do not notice any loss of arm or shoulder function following a proximal biceps tendon rupture. A slight bulge in the arm, and some twitching of the retracted muscle are usually the most significant symptoms. Surgical repair of the proximal biceps tendon is usually only considered in the case of a younger patient who is more active.

The reason there is little functional loss following a proximal biceps tendon rupture is that there are actually two tendinous attachments of the biceps at the shoulder joint (that is why the muscle is named "bi-ceps," meaning two heads). When the rupture occurs at the distal biceps tendon at the elbow, where there is only one attachment, surgical repair is much more commonly needed.

I think I would also seek a second opinion, and I would look for somebody with particular expertise in sports medicine and swimming specifically. Treatment for many conditions seems to be based on the general population, and your world-class swimming puts you in a different class entirely, age notwithstanding.

If I had to guess, however, I would suspect that you would be better off not having surgery. Like Rich's second case, it seems to be fine to skip the surgery for reattachment because the biceps has a second attachment point in the shoulder already.

Regardless of which treatment you take, I am confident you'll do fine. But you might want to talk to a rehab specialist to see if there might be some exercises you can do to bolster the surrounding musculature and take some of the pressure off your biceps.

Re: Torn biceps question

Firstly, thanks Jim, for looking into this. I read the same and wondered about why they think anyone over 40 is no longer "active" but also read Rich's comments (sheesh, both arms!) and will write to him for more information. Bottom line, I don't want to lose ability and power and it doesn't seem that happened to Rich!!

Thanks for the link from msgrupp.

Steve, yeah, it happened off the blocks of the 50 fly. Instead of being focused entirely on my underwater and breakout, I was kind of freaking out ... but kept swimming. It hurt some, felt awkward and clunky, and hurt more when I finished. Had I been wrestling I can't see how I could have continued. One nasty sport, that.

Re: Torn biceps question

Originally Posted by gshaw

I read the same and wondered about why they think anyone over 40 is no longer "active".

I think it is sometimes hard to convince a doctor that people in their 50s or 60s could really be interested participating in a competitive sport. When I broke both shoulders skiing, my shoulder specialist seemed to have little concern over whether I would be able to swim again. He told me that I would probably only be able to swim breaststroke but he advised that there were plenty of other physical activities I could do to keep in shape.

I guess that what we do is outside the norm for most of the people they treat and that they are normally pleased with an outcome which allows the return to "normal" activities.

Re: Torn biceps question

I have learned a few things about this injury and it seems that an athlete can perform at a very high level with a biceps tear/separation of the long bicep muscle. Rich Abrahams has accomplished some of his best swimming with this condition and if anyone is interested in reading about athletic accomplishments with this injury I suggest you google "John Elway biceps tear" and see what you get. He won two super bowls with a biceps tear in his throwing arm.

Re: Torn biceps question

Greg, If it's of any additional consolation, a fellow swimmer at our Y had the same injury. He builds pools for a living and is one tough guy for his 60 years. Picture John Wayne without the cowboy drawl.

Anyway, while working on a patio a couple of years ago he lifted a large piece of flag stone still thinking he had the brute strength of his youth. Much to his surprise his bicep rolled back up his arm like one of those birthday party horns when it retracts. A long story short they reattached the muscle and he's as good as new.

Thanks to modern medicine they can rebuild us older athletes when things start coming undone.

Re: Torn biceps question

Rich,

I ruptured my bicep tendon 3 weeks ago.
Did u lose a lot of strength? With ur tenotomy ?
How many weeks after the tenotomy did
U go back in the pool ?
Has ur popeye become more pronounced
Over the years?
Are u still doing curls? Is that making the
Deformity shift more south?
Is the divet between shoulder and bicep
Progressing over the years?
Trying to get a feel for how rupture affect
Strength and cosmesis.
Thanks
Eric (45)

Re: Torn biceps question

Originally Posted by Exvandoorn

Rich,

I ruptured my bicep tendon 3 weeks ago.
Did u lose a lot of strength? With ur tenotomy ?
How many weeks after the tenotomy did
U go back in the pool ?
Has ur popeye become more pronounced
Over the years?
Are u still doing curls? Is that making the
Deformity shift more south?
Is the divet between shoulder and bicep
Progressing over the years?
Trying to get a feel for how rupture affect
Strength and cosmesis.
Thanks
Eric (45)

Eric,
First, I'm assumming you're asking about the tendon that I did not have reattached. It never ruptured, but was released during an operation to repair a torn labrum in Sept. of '05. Not a very long recovery as I recall and the length was due primarily to the labrum. Probably swimming within 3 months. Too lazy to look it up in my 2005 training log. I never had the popeye bulge as my docs did a special post op wrap that prevented it and it has not changed over the last 7 years. While the passing years have affected my strength, I don't think the operation had anything to do with that! I don't do curls very often, prefering pullups and I did manage 5 really good ones (touch shoulders to the bar and full extention at the bottom) with 25 lbs.strapped on, so the strength is hanging on. I could do 12 when I was only 60.

Re: Torn biceps question

Just curious. In last three weeks I have left practice with red "welts" at top of arm just beneath shoulder. Looks as if someone gripped my arm really hard. Very tender to touch. In looking up where biceps tendon attaches, it seems that this is where I am getting these welts. I SHOULD KNOW EVERY FRICKIN' shoulder exercise, since I do a ton, but what might help me strengthen this area? I'm thinking it may have more to do with my shoulder and less to do with my biceps.

Anyone struggle with this? I don't never wanna have shoulder surgery again; took me two years to get back to my current state, which is good enough for me though not Top 10, cetera. Have an appt. with ortho next week, but she was very "you'll never swim again" after I had my shoulder surgery in 2010, and not very knowledgeable about PT post-op. Happily I have a great PT who showed me how to get back flexibility and strength. But it took a long time.

Re: Torn biceps question

Originally Posted by Rich Abrahams

Eric,
First, I'm assumming you're asking about the tendon that I did not have reattached. It never ruptured, but was released during an operation to repair a torn labrum in Sept. of '05. Not a very long recovery as I recall and the length was due primarily to the labrum. Probably swimming within 3 months. Too lazy to look it up in my 2005 training log. I never had the popeye bulge as my docs did a special post op wrap that prevented it and it has not changed over the last 7 years. While the passing years have affected my strength, I don't think the operation had anything to do with that! I don't do curls very often, prefering pullups and I did manage 5 really good ones (touch shoulders to the bar and full extention at the bottom) with 25 lbs.strapped on, so the strength is hanging on. I could do 12 when I was only 60.

Rich

Rich -

You have my attention! On Aug 2 I broke my clavicle in a bike wreck. Since then I have been struggling with a frozen shoulder. Last week I had an MRI which indicated SLAP Tear. The doc wants to do the Tenotomy (release the biceps Tendon). My concern was the impact on swimming. Before I read your report I was concerned that there would be loss of strength in the bicep. I am also interested in more details on the post op wrap.